Ca²⁺-dependent regulation of sodium channels Na_V1.4 and Na_V1.5 is controlled by the post-IQ motif.

Skeletal muscle voltage-gated Na⁺ channel (Na_V1.4) activity is subject to calmodulin (CaM) mediated Ca²⁺-dependent inactivation; no such inactivation is observed in the cardiac Na⁺ channel (Na_V1.5). Taken together, the crystal structures of the Na_V1.4 C-terminal domain relevant complexes and thermodynamic binding data presented here provide a rationale for this isoform difference. A Ca²⁺-dependent CaM N-lobe binding site previously identified in Na_V1.5 is not present in Na_V1.4 allowing the N-lobe to signal other regions of the Na_V1.4 channel. Consistent with this mechanism, removing this binding site in Na_V1.5 unveils robust Ca²⁺-dependent inactivation in the previously insensitive isoform. These findings suggest that Ca²⁺-dependent inactivation is effected by CaM's N-lobe binding outside the Na_V C-terminal while CaM's C-lobe remains bound to the Na_V C-terminal. As the N-lobe binding motif of Na_V1.5 is a mutational hotspot for inherited arrhythmias, the contributions of mutation-induced changes in CDI to arrhythmia generation is an intriguing possibility.

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